The risk of haemorrhage associated with early postoperative heparin administration after intracranial surgery

Background To analyse the rate of postoperative haemorrhage during a 4-year period of early postoperative administration (<24 hours) of fractionated h eparin plus compression stockings in a large cohort of patients undergoing intracranial surgery. Method. A total of 1564 patients who underwent intracranial surgery at our institution were included in our study. 1197 of the 1564 patients (77%) had major intracranial surgery (group 1). Group 2 was made up of 367 patients in whom ventriculoperitoneal shunting or external ventriculostomy was perfo rmed (minor intracranial procedures). All patients were investigated retros pectively for the occurrence of major postoperative haemorrhage confirmed b y CT scanning and requiring surgical evacuation. The protocol for prophylax is of thrombo-embolic events included early (<24 hours) postoperative fract ionated low-dose heparin (3 x 5000 IE subcutaneously) until discharge plus intra- and postoperative compression stockings. Findings. Major postoperative haemorrhages were observed in 31 of the 1564 patients (2.0%). In three patients, the haemorrhage occurred on the day of surgery before the administration of heparin. The haemorrhage rate of patie nts receiving heparin was 1.8% (28/1564). All haemorrhages occurred in pati ents undergoing major intracranial procedures (group 1; 31/1197; 2.6%). The re was no haemorrhage in minor intracranial procedures (group 2; 0/367; 0%) . Interpretation. Although retrospective, this is to date the largest study s upporting the concept of postoperative pharmacological thrombo-embolic prop ylaxis in patients undergoing intracranial surgery. The question as to whet her pharmacological prophylaxis is beneficial for a given patient can only be answered by weighing the risk reduction of thrombo-embolic events agains t the risk increase of postoperative haemorrhage associated with different surgical procedures and heparin protocols.